All Articles Written by Kathryn Disney-Etienne, CCS-P, RT
All Articles Written by Kathryn Etienne, CCS-P - RETIRED
Welcome to the archived list of all medical billing articles written and previously posted to the site by Kathryn Etienne, CCS-P, retired Director of Operations.
All articles are listed below and categorized by date, newest to oldest. Click any article link below to read the entire article.
Medical Necessity Can Make or Break Your Claim
Along with documentation, medical necessity is one of the most important parts of medical billing. You tell exactly how the procedure was performed, be sure to meet the criteria for medical necessity of the procedure by telling why the procedure needed to be performed. It used to be that Medicare was the only payer that cared what ICD-9 code was used. Now all payers, including insurance companies, are looking for any reason not to pay the bill or at least delay it. ICD-9 codes have become the target for close scrutiny. ICD-9 codes range anywhere from a three-digit code to a five-digit code. Obviously, a five digit code is more …
Coding for Oxygen Administration
Coding a medical billing claim for oxygen administration can be a tricky beast because there is not a specific oxygen administration code assigned. Normally the administration of oxygen is bundled into an emergency visit. When a doctor prescribes the oxygen, you should use the appropriate office visit code that describes the procedure and services performed by the physicians that necessitates the need for oxygen. Full documentation of the medical billing claim will insure that your bundled oxygen administrations codings get full reimbursement. For example if you have a physician who performs a detailed examination on a patient and decides to administer oxygen to a known patient who is in the …
Breaking Down a Breast Biopsy
Here is a perplexing problem. When a surgeon meets with a patient an recommends a breast biopsy, we report a consult for this particular visit. On the day of the biopsy procedure, the surgeon will re-examine the patient, answer questions, an so on. The time that is spent prior to the procedure is ten minutes. In a case like this, you will not report a separate E/M with the biopsy. It is important to remember that all procedures include an inherent E/M component, according to CPT and CMS guidelines. In order to qualify as a separately billable service, any E/M the physician provides must be both signifigant and separately identifiable …
Are You Guilty of Undercoding?
It’s a dirty little secret in the medical industry that many physicians fail to get the maximum reimbursement on their medical billing claims because they undercode their medical billing claims. Doing this on a frequent basis can cause your practice to lose up to one quarter of your reimbursement revenue. Undercoding also happens because the coding is left up to the staff in the office to perform and this method is guaranteed to have errors and omissions because the staff has no way of knowing exactly which services occurred in the exam room and which did not. Since notes don’t always get made at the time of the procedure, reimbursable …
Getting Your Moderate Sedation Medical Billing Codes Straight
In late 2006, the CPT added some new codes in their revision. Previously there would have been a need to bill for extra units to capture a procedures base units. With the release of the new moderate sedation codes (99143-99150). The need to bill extra units to capture the procedure’s base unit amounts. Therefore, you should ignore billable units and instead use new time-based codes. A good example would be if a doctor did a procedure that involved 30-minutes of sedation. Previously you would have use 01922 anesthesia designation, you would have used 7 base units and 2 time units (15 minutes = 1 time unit) and you have used …
